Routine use of
steroids in the treatment of
bacterial meningitis remains controversial. A prospective placebo controlled double blind study of
dexamethasone was carried out in 40 patients (age>10 years) of acute
bacterial meningitis. The patients were randomly assigned to receive either placebo (n=20) or
dexamethasone (n=20) in addition to injection
ceftriaxone 100 mg/kg/day (maximum 4 gm/day) for 14 days.
Dexamethasone sodium phosphate was given in dose of 0.6 mg/kg/day in 4 divided doses, for first 4 days of
therapy. First dose of
dexamethasone was given 15 minutes prior to first dose of
ceftriaxone. Baseline demographics, clinical and laboratory features of the two groups were similar. Clinical improvement of signs of meningeal irritation was rapid in
dexamethasone group than in the placebo group, but no significant difference was observed regarding resolution of
fever,
headache and
vomiting. Secondary
fever (mean+/-SD 15.00), gastrointestinal tract
bleeding (mean+/-SD 15.00) and psychiatric manifestations (mean+/-SD 10.00) were more common in
dexamethasone group. Neurological complications and
hearing loss were more common and severe in placebo group as compared to the
dexamethasone group (p<0.05). It is concluded that
dexamethasone may be beneficial in some aspects of
bacterial meningitis, in adults. A study with a larger number of cases in each group is recommended.